Hong Kong Eye Hospital2012 Quality Assurance Forum

Standardization of A&K Measurement Record

22 March 2012

PAPDNSAPN CHIU Wai Yee

Background

• Cataract extraction and IOL implantation is the most common surgery in HKEH. (~ 6200 cases / year)

• A&K measurement record is one of important clinical and legal documents.

• 3 professions involve in measurement of the power of IOL (Orthoptist, Optometrist & nurse)

• Different professions produce different formats of measurement records

• More than 5 types of machines are used to measure axial length.

Challenge

• Potential medical incident: wrong IOL insertion post-op refraction surprise

• Time consuming in “Time-out” procedure lengthen operative time

• Reprint A&K record according to surgeon’s preference on OT day interruption of service

• Need manual calculation if IOL of other model is required peri-operatively calculation error

Review of Old A&K measurement

Using Canon within one department

Using Nidex by

different departments

Using different types of machine within one department

Using IOL Master by different staffs within

one department

Improvement work• A work group was formed and leaded by

Dr NM Lam and L Wong.• Members comprised of all concerned parti

es, e.g. orthoptist, optometrist, DSU nurse, PAPD nurse

• The 1st meeting was held on 15 July 2011.• 1st version of standardized A&K measure

ment record was used from September 2011.

• 2nd version of standardized record was used by all departments of HKEH and UEC from Jan 2012 to present.

Aims of Standardization

11 Patient safety• Correct IOL model and diopter is i

mplanted into the correct eye

11 Efficiency confusion caused by different fo

rmat of print out the checking time of IOL model

& diopter• Facilitate “Time out” procedure

Aims of Standardization

11 Smoothness of service the frequency of changing IOL

on table choice of IOL models at printout ad hoc reprint IOL

4. Better communication between all staffs (surgeon, day ward nurse, OT nurse, Shroff)

5. Proper documentation

1st version of standardized A&K Measurement Record

2nd

version

2nd

version

Reprint

A&K form

Print-out by IOL Master

Print-out by IOL Master